Abstract WMP92: Health Insurance Coverage is Associated with Mortality after Stroke
Background: Management of treatable risk factors is of paramount importance to decrease stroke mortality and improve outcomes after stroke. Optimizing healthcare access serves as a foundation for risk factor management. The association between health insurance type and mortality after stroke warrants investigation.
METHODS: Using data from the National Health and Nutrition Examination Surveys 1999-2004 with follow up mortality assessment through 2006, we examined the relationship between health insurance and (1) stroke mortality among all adult participants (n=15,049) and (2) vascular and all-cause mortality among participants with self-reported stroke (n=563). The relationship between insurance type and the aforementioned outcomes were evaluated using Cox regression after adjusting for covariates (age, sex, race, income, BMI, and major medical comorbidities).
RESULTS: Among 10,786 participants <65 years (representing 163,891,359 individuals in the US) 69% had private insurance, 21% were not insured and 4% had Medicaid. Among 4,263 participants ≥ 65 years (representing 33,375,771 individuals in the US), 43% had Medicare + private insurance, 41% had Medicare only, 8% had private insurance only and 4.2% had Medicare + Medicaid. Stroke survivors ≥65 years with private insurance were less likely to die from vascular causes compared to those with Medicare alone (adjusted HR 0.38, CI 0.23-0.63, p<0.001). The same subjects had lower all-cause mortality if they had Medicare + private insurance compared to Medicare alone (adjusted HR 0.63, CI 0.37-1.08, p=0.07). Uninsured stroke survivors <65 years had similar all-cause mortality to those with insurance (adjusted HR 0.97, CI 0.29-3.23). In the general population, uninsured individuals <65 years were more likely to die of stroke than those with insurance (adjusted HR 3.13, CI 0.96-10.23, p=0.06); however, insurance status did not affect stroke mortality among individuals ≥65 years.
CONCLUSION: In this nationally representative sample of the US population followed for up to 7 years, insurance status appears to have a profound, independent impact on mortality rates after stroke. These findings highlight the importance of health insurance coverage in post-stroke outcomes.
- © 2012 by American Heart Association, Inc.